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Flashcards in PROTOCOLS 2 Deck (8)
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1

Agitated or Violent Patient/Behavioral Emergency: Adult & Pediatric

Adult:
– Midazolam: 5 mg IM/IN/IV/IO
Max total dose 20 mg
– Lorazepam: 2-4 mg IM or 2 mg IV/IO
Max total dose 4 mg
-Ketamine:
– 4 mg/kg IM/IN, max initial dose of 250 mg
– 2 mg/kg IV/IO, max initial dose 150 mg

Peds:
− Midazolam: 0.1-0.15 mg/kg IM or 0.05-0.1
mg/kg IV/IO or 0.3 mg/kg IN. Max initial
dose 5 mg
− Lorazepam: 0.05 mg/kg IM/IV/IO. Max initial
dose 2 mg IV/IO and 4 mg IM

2

Pain Management: Adult & Pediatric

Adult:
-Morphine: 0.1 mg/kg/dose IV/IO, max 2-5 mg increments, max total dose 15 mg.
• Reassess pain every 5 minutes.
• Evidence of serious adverse effects should preclude further morphine administration.
• If still in significant pain, re-dose at the original dose.
-Fentanyl: 1 mcg/kg/dose IN/IV/IO, max initial dose 100 mcg, max total dose 200 mcg.
-Ketamine: 0.25 mg/kg IV/IO, max per dose 25 mg, max total dose 100 mg.

Peds:
-Fentanyl: 1 mcg/kg/dose IN/IV/IO, max initial dose 100 mcg, max total dose 200 mcg.

3

Syncope and Presyncope: Adult & Pediatrics

Adults:
-If symptoms of poor perfusion, give 500 mL IV/IO fluid bolus, and repeat as necessary. Max 30 ml/kg. Titrate to SBP > 90.

Peds:
-If symptoms of poor perfusion, give 20 mL/kg IV/IO fluid bolus, repeat as needed. Titrate to age appropriate SBP (Abnormal Vital Signs) using push-pull methods.

4

Chest Pain/Acute Coronary Syndrome/ST-segment Elevation Myocardial Infarction (STEMI): Adult

Adult:
-Administer Aspirin 325 mg PO or 324 mg chewed
-Nitroglycerin 0.4 mg SL tablets or 1 full spray if SBP > 100 mm Hg. May repeat every 3-5 minutes x 2
-Morphine 0.05 mg/kg/dose IV, max of single dose of 3 mg. May repeat in 10 minutes to a total max
of 10 mg if pain unresolved, if blood pressure allows.
-Fentanyl 0.5 mcg/kg/dose IN/IV/IO, max total dose 200 mcg.

5

Syncope and Presyncope: Adult & Pediatrics

Adults:
-If symptoms of poor perfusion, give 500 mL IV/IO fluid bolus, and repeat as necessary. Max 30 ml/kg. Titrate to SBP > 90.

Peds:
-If symptoms of poor perfusion, give 20 mL/kg IV/IO fluid bolus, repeat as needed. Titrate to age appropriate SBP (Abnormal Vital Signs) using push-pull methods.

6

Chest Pain/Acute Coronary Syndrome/ST-segment Elevation Myocardial Infarction (STEMI): Adult

Adult:
-Administer Aspirin 325 mg PO or 324 mg chewed
-Nitroglycerin 0.4 mg SL tablets or 1 full spray if SBP > 100 mm Hg. May repeat every 3-5 minutes x 2
-Morphine 0.05 mg/kg/dose IV, max of single dose of 3 mg. May repeat in 10 minutes to a total max
of 10 mg if pain unresolved, if blood pressure allows.
-Fentanyl 0.5 mcg/kg/dose IN/IV/IO, max total dose 200 mcg.

7

Agitated or violent Patient/Behavioral Emergency

ADULT:
-MIDAZOLAM: 5mg IM/IN/IV/IO
Max total dose 20mg
-LORAZEPAM: 2-4mg IM or 2mg IV/IO
Max total dose 4mg
-KETAMINE: 4mg/kg IM/IN, max initial dose 250mg
2mg/kg IV/IO, max initial dose 150mg

PEDS:
-MIDAZOLAM: 0.1-0.15mg/kg IM or
0.05-0.1mg/kg IV/IO or
0.3mg/kg IN. Max initial dose 5mg
-LORAZEPAM: 0.05mg/kg IM/IV/IO. Max initial dose 2mg IV/IO and 4 mg IM

8

Pain Management

ADULT:
MORPHINE:
-0.1mg/kg/dose IV/IO, max 2-5mg increments, max total dose 15mg. Reassess pain every 5 minutes
FENTANYL:
-1mcg/kg/dose IN/IV/IO, max initial dose 100mcg, max total dose 200mcg
KETAMINE:
-0.25mg/kg IV/IO, max per dose 25mg, max total dose 100mg

PEDS:
FENTANYL:
-1mcg/kg/dose IN/IV/IO, max initial dose 100mcg, max total dose 200mcg